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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604253
Report Date: 03/11/2025
Date Signed: 03/11/2025 04:29:41 PM

Document Has Been Signed on 03/11/2025 04:29 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:TIZON'S PRIME CARE INC., #2FACILITY NUMBER:
374604253
ADMINISTRATOR/
DIRECTOR:		TIZON, GRACE CFACILITY TYPE:
735
ADDRESS:2215 SPRING OAK WAYTELEPHONE:
(619) 227-2010
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY: 4CENSUS: 4DATE:
03/11/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Caregiver Mary Jane ArnoldTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced visit to correct a 809-D Deficiency and Plan of Correction Facility Evaluation Report. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Caregiver Mary Jane Arnold.

LPA came to the facility to correct the Plan of Correction description on a LIC809-D, Deficiencies & Plans of Correction report, issued on 11/08/24. LPA corrected the report and had it signed by Caregiver Mary Jane Arnold.

No new deficiencies were identified or cited during today's visit.

An exit interview was conducted with Mary Jane. A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided, signature below confirms receipt of the documents.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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